Glue Ear

Glue ear is a condition in which a sticky glue-like fluid builds up in the middle ear chamber. It is an extremely common condition that affects mainly young children aged between two and five years. In most children, glue ear clears up on its own. However, up to 5% of children get persistent glue ear, which if left untreated, causes long term hearing loss. Physicians call glue ear “otitis media with effusion”, “secretory otitis media” or “chronic secretory otitis media”.

Glue Ear

Symptoms

The symptoms of glue ear vary with age. You may notice that a very young child gets repeated acute otitis media (inflammation of the ear). They may be clumsy. It might also take them longer to start to walk, speak or understand language.

Older children may be able to tell you if they cannot hear very well. You may notice that they say ‘pardon’ or ‘what’ a lot or that they turn the television up loud. Glue ear also makes older children clumsy and dizzy.

Causes

The middle ear needs to be full of air to let the eardrum and small bones vibrate freely. Air reaches the middle ear through the eustachian tube, which connects the middle ear to the back of the nasal cavities and throat. The eustachian tube is closed for 95% of the time and only opens when you swallow or yawn.

The lining of the middle ear is similar to that in the lungs in that air is absorbed through outer lining of the middle ear and into the bloodstream. This means that unless the eustachian tube opens properly to replace the air, you eventually lose air from the middle ear space .

Children have a narrow and sometimes blocked up eustachian tube, which stops it from opening properly. This can lead to a vacuum in their middle ear. Once this vacuum has formed, the lining of the middle ear becomes inflamed as the inner ear lining becomes inflamed. As part of the inflammation reaction, a thin fluid seeps out from this lining into the middle ear space. The fluid then becomes thicker preventing the eardrum and small bones (ossicles) from vibrating. Unless the ossicles can vibrate, now vibrations get from the ear drum to the inner ear receptor (cochlea).

Treatment

The treatment your doctor (family or pediatrician) offers for glue ear will depend on how long your child has had glue ear, how bad the problem is, how much their language and development are affected, and the number of bouts of glue ear they have had.

There are three main methods of treatment:

Treatment is required, first is usually medicine(s) to reduce the swelling of the Eustachian tube thus opening it and allowing the accumulation (“glue”) to drain down the back of the throat. Some doctors prescribe oral decongestants to thin the fluid in the ear and help it drain away and some doctors prescribe antihistamines or nasal steroids in the form of drops or sprays for children with allergies – both of which help reduce the swelling of the Eustachian tube.

The second treatment is if there is a suspected infection. An infection is often accompanied by pain as bacteria grow within the middle ear chamber and because of the blocked Eustachian tube, begin to put pressure outward on the ear drum. Antibiotics are usually prescribed, sometimes initially by injection, then a regimen orally three times a day for at least 7 days.

In the past, antibiotics such as penicillin, erythrosine, or erythromycin were prescribed. However, in the last few decades, many in the general population have become immune to the effects of these antibiotics, and stronger ones are often prescribed. The cause of immunity is often blamed on antibiotics fed to the food supply (chickens and beef) before they are brought to market.

These approaches are usually effective for most children. If your child continues to have problems, your doctor may decide to refer them to an ear, nose and throat (ENT) specialist.

Surgical treatment using grommets

If your child has had glue ear over a few months and antibiotics have not worked, the other option is to have a small ventilation drain known as a grommet inserted into the era drum. This procedure involves making a small hole in the eardrum and inserting the grommet through the hole. Initially fluid is sucked out of the middle ear through this hole, then over a few months, the grommet ets air into the middle ear space and lets fluid in the middle ear drain away.

This procedure is known as a myringotomy. It is carried out under a short general anesthetic and takes about 15 minutes. Your child will usually be allowed to go home the same day.

What happens to the grommet?

The grommet slowly moves outwards as the eardrum grows. It is then naturally pushed out of the eardrum into the outer part of the ear. It moves outwards with earwax until it falls out of the ear canal, often unnoticed.

Most grommets fall out nine to 12 months after insertion but they can also easily be removed at a follow-up ENT appointment.

Over half of children who have grommets do not need further surgical treatment as they get older. However, 30% of children will need grommets inserted a number of times until their glue ear improves.

Looking after a child with grommets

The hole in the eardrum for grommet insertion is small, however, it is worth taking a few simple precautions to stop water getting into your child’s ear:

Your child should swim on the surface of the water only and not dive.

Use earplugs or cotton wool with Vaseline to stop soap water getting into the ears when showering or washing their hair.

Flying is actually easier for a child with a grommet in their ear. The grommet allows air in and out of the ear and reduces the stress on the eardrum that is caused by changes in air pressure in the aircraft. However, children who have a history of frequent ear infections or have had grommets in the past (but no longer have them) are occasionally at risk of perforation of the eardrum when flying. If you are worried about this, ask your doctor.

About 5% of children with grommets get an ear discharge at some time, often after a cold. This is usually not serious or painful, but it is important to keep your child’s ears clean and to consult your doctor as soon as possible. Your doctor will usually prescribe antibiotics or eardrops.

If your child gets a lot of discharge, gently clean their ears using a twist of clean cotton wool or a very soft cloth. Never use a cotton-tipped ear cleaning stick as you may go too far into the ear and cause damage. If infections are treated quickly, the ears will get back to normal with the grommets in place in most children.

Other surgical treatment for glue ear

Other surgical treatment for glue ear involves an ‘adenoidectomy’ or surgical removal of the adenoids. The adenoids are located above the tonsils, at the back of the throat. They get larger between birth and four years of age and then become progressively smaller. By adulthood they have disappeared altogether. The tonsils and adenoids are thought to assist the body in its defense against incoming bacteria and viruses by helping the body to form antibodies.

With ear infections, the adenoids often swell, usually due to an infection in the immediate area, in this case, the middle ear. However, the reverse is also true. If there is an infection in the throat and the tonsils and adenoids swell, they can sometimes cause a middle or inner ear infection.

An adenoidectomy is commonly carried out in children over the age of three and is thought to help stop a child from getting glue ear again. Removing their adenoids does not harm a child. Adenoids are removed through the mouth under general anesthetic and thechild is usually allowed to go home the same day.

How you can help your child

Make sure your child has been properly assessed by your doctor who may refer you to an ENT specialist.

If you suspect that an allergy is causing glue ear, ask the ENT specialist about this.

Avoid smoking near your child.

While waiting to see if glue ear clears up on its own or waiting for grommet surgery, children sometimes have reduced hearing for quite some time and will need help with communication. During this time, they may need to use a hearing aid and have support at home and school. Here are some ways in which you can make communication easier with your child:

Reduce background noise when talking to your child, for example turn down the television.

Attract their attention before you start speaking to them.

Put your head at their level. Do not shout.

Speak clearly. Do not exaggerate mouth movements.

Let family and teachers know about the problem.

Remember that glue ear usually stops being a problem well before puberty.